Do You Really Need a Colonoscopy? Your Gastrointestinal Symptoms

Is a colonoscopy necessary?

Hello Doctor, for the past six months to a year, my stools have been unformed, alternating between diarrhea and constipation.
Sometimes I feel the urge to have a bowel movement, but I can't go, or I feel like I haven't fully emptied my bowels.
The clinic doctor suggested it might be irritable bowel syndrome.
I have taken digestive aids and anti-gas medications, but my condition hasn't improved; it fluctuates between good and bad.
Sometimes I experience bloating and nausea, making it difficult to eat.
I can only manage a few bites of food before feeling like I need to vomit.
At times, I feel hungrier but still can't eat, as if my stomach is empty but food makes me nauseous.
I'm really at my wit's end.
In the last month or two, I've also experienced intermittent mild cramping in my lower abdomen, which is uncomfortable but not severe.
Due to my constipation issues, I often lie down and massage my abdomen.
Pressing around my navel can be painful, especially in the lower right area, while above the navel, there seems to be a lump.
I'm not sure if it's gas.
After switching to another clinic, the doctor performed an abdominal ultrasound and hesitated to speak, mentioning that a small section of my intestine appears swollen and that the mucosa and mucus don't seem normal.
They recommended a colonoscopy.
Should I not first undergo a fecal occult blood test or other evaluations before going directly to a colonoscopy? I am concerned that the colonoscopy might worsen my anal fissures due to my history of long-term diarrhea and constipation.
Thank you.

Hou Nai Cha, 20~29 year old female. Ask Date: 2019/05/30

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Abdominal ultrasound examination of the gastrointestinal tract is not very helpful.
The likelihood of irritable bowel syndrome (IBS) is high.
If symptoms persist, a colonoscopy may be considered.

Reply Date: 2019/05/30

More Info

Based on your symptoms and the medical history you've provided, it seems that you are experiencing a complex set of gastrointestinal issues that could be indicative of Irritable Bowel Syndrome (IBS) or another functional gastrointestinal disorder. Your symptoms of alternating diarrhea and constipation, along with feelings of incomplete evacuation and abdominal discomfort, align with common presentations of IBS. However, the presence of significant abdominal pain and changes in bowel habits over an extended period raises concerns that warrant further investigation.

The recommendation for a colonoscopy, especially after an ultrasound indicated abnormal findings in your intestines, is a prudent step. While stool tests, such as a fecal occult blood test, can help rule out bleeding or other issues, they may not provide a complete picture of your gastrointestinal health. A colonoscopy allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as inflammation, polyps, or other structural issues that could be contributing to your symptoms.

It's understandable to be concerned about the potential for a colonoscopy to exacerbate existing conditions, such as anal fissures. However, a colonoscopy is generally considered safe, and the benefits of obtaining a clear diagnosis often outweigh the risks. If you have concerns about your anal fissures, it would be beneficial to discuss these with your gastroenterologist prior to the procedure. They may be able to take precautions to minimize discomfort during the examination.

In terms of managing your symptoms in the meantime, dietary modifications can play a significant role. Many individuals with IBS find relief by following a low-FODMAP diet, which involves reducing certain fermentable carbohydrates that can exacerbate gas, bloating, and diarrhea. Additionally, keeping a food diary may help identify specific triggers that worsen your symptoms.

Stress management techniques, such as mindfulness, yoga, or cognitive-behavioral therapy, can also be beneficial, as stress is known to impact gastrointestinal function. Since you mentioned feelings of anxiety and frustration regarding your symptoms, seeking support from a mental health professional may provide additional coping strategies.

In conclusion, while it may seem daunting, proceeding with the colonoscopy is a reasonable course of action given your symptoms and the findings from your ultrasound. It will provide valuable information that can guide your treatment plan moving forward. In the meantime, consider dietary adjustments and stress management techniques to help alleviate some of your symptoms. Always communicate openly with your healthcare provider about your concerns and any new symptoms that arise, as this will help them tailor the best approach for your care.

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